Healthcare Provider Details

I. General information

NPI: 1528921418
Provider Name (Legal Business Name): PETER C. SHORTS LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69550 HIGHWAY 111 STE 202&203
RANCHO MIRAGE CA
92270-2825
US

IV. Provider business mailing address

69550 HIGHWAY 111 STE 202&203
RANCHO MIRAGE CA
92270-2825
US

V. Phone/Fax

Practice location:
  • Phone: 760-902-4961
  • Fax: 760-507-8405
Mailing address:
  • Phone: 760-902-4961
  • Fax: 760-507-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PETER CHARLES SHORTS
Title or Position: CEO
Credential: LCSW
Phone: 760-902-4961